🔹 Webinar Focus: Oxygenator Failure & Crisis Management
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Analogy: Treat oxygenator failure like cardiac arrest – act fast.
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Failure signs:
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Drop in SpOâ‚‚ and MAP, increased agitation.
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Dark return blood, rising delta pressure (pre/post membrane).
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Diagnosed using:
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Blood gases (low PaOâ‚‚, high PaCOâ‚‚, acidosis).
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Pressure gradients (pre/post membrane).
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Biochemical markers (↑free Hb, LDH; ↓platelets, fibrinogen).
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🔹 Management Protocol
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Prioritize systemic oxygen delivery before oxygenator exchange.
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Initiate exchange protocol: ventilator support may be temporarily increased.
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Ensure clear role delegation among team members:
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ECMO specialist: Prepare circuit.
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ICU nurse: Monitor/support patient.
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Intensivist: Lead, coordinate.
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Perfusionist: Assist circuit exchange.
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Team debriefing post-event is critical for improvement and safety.
🔹 MCQ Highlights
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Dark return blood is the early warning sign of oxygenator failure.
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Most reliable indicator: rising pre/post membrane pressure gradient.
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Key action before exchange: call for emergency change, not reduce pump speed.
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After exchange: document, debrief, and analyze system/process.
🔹 Additional Key Points
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Acute deterioration → Immediate action.
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Gradual dysfunction → MDT discussion.
Crisis vs. elective oxygenator exchange:
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VV ECMO patients can tolerate longer periods without anticoagulation.
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Circuit changes may carry risks; balance decisions with clinical context.
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Oxygenator failure causes:
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Thrombosis (most common), plasma leak, sweep gas issues.
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🔹 Educational Emphasis
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Simulation-based training is essential (like ACLS, PALS).
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Ongoing education, protocols, drills, and crisis preparedness must be embedded in practice.
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Future sessions will include realistic simulation training to improve crisis response.